Spotting fetal growth problems early could cut UK stillbirths by 600 a year
The authors say spotting it early could substantially reduce the risk, and this needs to become a cornerstone of safety and effectiveness in antenatal care.
Stillbirth rates in the United Kingdom are among the highest in developed countries. They have often been considered unexplained and unavoidable, and their rates have changed little over the last two decades.
Recently, doctors have found that many stillborn babies fail to reach their growth potential, prompting a renewed focus on what causes fetal growth restriction. So a team of researchers at the West Midlands Perinatal Institute in Birmingham set out to assess the main risk factors associated with stillbirth in a multiethnic population.
Using NHS records, they identified 92,218 normally formed singleton babies, including 389 stillbirths, from 24 weeks of gestation, delivered during 2009-11 (a stillbirth rate of 4.2 per 1,000 births). They then assessed several maternal and fetal risk factors for stillbirth and calculated the proportion of stillbirths that could be potentially avoided if these risks were removed.
These included mother's age, parity (the number of times she had given birth), body mass index, mental health history, pre-existing diabetes, high blood pressure or heart disease, smoking in pregnancy, alcohol consumption, and fetal growth problems.
First, third and subsequent pregnancies were associated with an increased risk of stillbirth compared with second pregnancies, but high maternal age carried no increased risk in this population which excluded congenital anomalies. Ethnicity (African, African-Caribbean, Indian and Pakistani) carried a higher risk, as did deprivation and unemployment of the mother or her partner.
Maternal obesity (BMI of 30 or more), smoking, pre-existing diabetes, a history of mental health problems, and fetal growth restriction were all associated with a significantly increased risk.
As potentially modifiable risk factors, maternal obesity, smoking in pregnancy and fetal growth restriction together accounted for 56% of all stillbirths.
However, the strongest risk factor was fetal growth restriction, which carried a fourfold higher risk of stillbirth compared with normal growth pregnancies. This increased to an eightfold risk if it was not detected during pregnancy, accounting for 32% of all stillbirths in the study.
Yet the authors point out that the presence of fetal growth restriction is currently missed in most pregnancies.
They estimate that 71 stillbirths in their study population could have been avoided through better antenatal recognition. Extrapolated to the UK population, this would represent 600 fewer stillbirths per year.
"Our study shows that while there are several risk factors for stillbirth that can be ascertained from the outset of pregnancy, the single largest factor is fetal growth restriction, which is currently not well predicted and not recognised antenatally in most pregnancies," say the authors. "Most normally formed singleton stillbirths are potentially avoidable … and preventive strategies need to focus on improving antenatal detection," they conclude.
In an accompanying editorial, two experts from the University of Auckland say this study adds "important new insights" about modifiable risk factors for stillbirth, but that efforts to improve detection of fetal growth restriction must be intensified.
Provided by British Medical Journal
- Slow-growing babies more likely in normal-weight women; Less common in obese pregnancies Apr 27, 2012 | not rated yet | 0
- Stillbirth rate twice as high among least well off in England Jun 26, 2012 | not rated yet | 0
- Study finds higher risk of stillbirth in women with fibroids Feb 06, 2010 | not rated yet | 0
- Smallest and largest fetuses at greater risk of being stillborn, research finds Jun 25, 2012 | not rated yet | 0
- Stillbirth risk affected by mother's sleep position Jun 16, 2011 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Classical and Quantum Mechanics via Lie algebras
Apr 15, 2011 I'd like to open a discussion thread for version 2 of the draft of my book ''Classical and Quantum Mechanics via Lie algebras'', available online at http://lanl.arxiv.org/abs/0810.1019 , and for the...
- More from Physics Forums - Independent Research
More news stories
A new smartphone application, developed by scientists at the University of Ulster, which could help older people engage fully in an increasingly self-serve society, may be ready for use by the end of the ...
Health 3 minutes ago | not rated yet | 0
As health services strive to improve quality and reduce costs, researchers study the benefits – and the pitfalls – of 'pay for performance' in hospitals.
Health 13 minutes ago | not rated yet | 0 |
(Medical Xpress)—There is no significant risk directly associated with air travel during pregnancy, even at advanced gestation, says report by the University of Liverpool.
Health 33 minutes ago | not rated yet | 0
To coincide with the broadcast of Jabbed: Love, Fear and Vaccines (SBS ONE, Sunday 26 May at 8.30pm) the first ever national survey on Australian attitudes to vaccination reveals surprising statistics including half of Australians ...
Health 50 minutes ago | not rated yet | 0
(Medical Xpress)—Researchers at the University of Virginia School of Medicine have identified a promising target for treating glioblastoma, one that appears to avoid many of the obstacles that typically frustrate efforts ...
1 hour ago | not rated yet | 0 |
(Medical Xpress)—The first symptoms of major depression may be behavioral, but the common mental illness is based in biology—and not limited to the brain.
1 hour ago | 5 / 5 (1) | 0 |
For the first time, physicists from the Max Planck Institute for Extraterrestrial Physics (MPE), biologists and physicians demonstrated the synergistic effect of cold atmospheric plasma - a partly ionized ...
3 minutes ago | not rated yet | 0 |
(Medical Xpress)—Scientists at Emory Vaccine Center have shown that an immune regulatory molecule called IL-21 is needed for long-lasting antibody responses in mice against viral infections.
57 minutes ago | not rated yet | 0 |
Human breastmilk responds quickly to protect the child when there is an infection in mothers or babies, according to new international research led by The University of Western Australia.
1 hour ago | not rated yet | 0
(Medical Xpress)—According to the World Health Organization, approximately 70 million couples experience infertility worldwide. Current data suggests that nearly one third of infertility disorders are due ...
23 minutes ago | not rated yet | 0